機械壓胸機架設時間與到院前心肺功能停止病人預後之相關性

Abstract

到院前心肺功能停止(Out-of-hospital cardiac arrest, 簡稱為OHCA)是全球公共衛生的重要議題。根據過往研究，早期發現、持續高品質的心肺復甦術(Cardiopulmonary resuscitation, 簡稱為CPR)、必要時施行除顫電擊以及快速轉送至後續醫療照護中心是改善患者預後的關鍵因素。考量台灣當地緊急救護人手短缺和轉送困難，機械壓胸裝置(Mechanical cardiopulmonary resuscitation devices, 簡稱為mCPR)的運用成為隊員為了維持高品質心肺復甦術經常使用的器材，然而mCPR架設過程中的時間變項跟患者預後有無相關，目前尚無研究進行探討。我們希望藉此研究找出急救過程中，哪段時間跟病人預後有顯著相關，這些是我們需要注意且可以主動介入的部分。 我們收集了2022年1月至9月間新北市政府消防局負責救護及載送的所有OHCA患者資料。2019年成立的新北市政府消防局品質管理小組，負責審閱隊員隨身佩戴的秘錄器影像，藉此精準測量mCPR架設以及整體急救過程中所有相關的時間變項。在此研究中，我們整合了救護人員現場完成的電子救護記錄表中紀錄的病人背景資料、品質管理小組提供的影像資料以及急救責任醫院醫院回傳的病人預後這三個來源的數據。 利用上述資料，我們分析了mCPR架設完成時間與患者預後間的關係。儘早將mCPR架設完成與提高OHCA患者ROSC的機率存在相關性，尤其是在初始為可電擊心律的病人相關性更為顯著；在面對初始心律為可電擊心律的患者時，每延遲一分鐘將mCPR架設完成，ROSC勝算就減少10.8%。同時，我們透過了不同的統計模式及驗證方法，發現mCPR架設完成時間之切點為316秒，是使用mCPR的OHCA病患預後出現顯著差異的時間切點。 本研究結果提供了到院前緊急救護人員面對OHCA病患時，對於不同初始心律的病人有關mCPR架設完成時間明確的實證建議以及訓練目標，在未來也有發展為mCPR使用指南之潛力。

Out-of-hospital cardiac arrest (OHCA) is an important issue in global public health. Early detection, continuous high-quality cardiopulmonary resuscitation (CPR), necessary implementation of defibrillation shocks, and subsequent medical transfer are all key factors to improve the prognosis of patients. Considering the shortage of local paramedic manpower and the difficulty of transportation, mechanical cardiopulmonary resuscitation (mCPR) devices has become a common option to maintain CPR quality. However, it is unclear how the time variables in the application of mCPR will affect the prognosis of patients. In this research, we aim to find out which time periods of resuscitation will significantly affect patient's prognosis, and the time periods allow us to interrupt and pay more attention to. We collected the records of OHCA patients from the New Taipei City Government Fire Department (NTFD) from January to September, 2022. The quality management team of NTFD is responsible for analyzing the images of body-worn videos from field team members and extracting associated time variables of mCPR implement and interrupt time during resuscitation. In this study, we integrate data from three sources, include patients’ demographic from electronic record collected by paramedic on scene, the image data from the quality management team and the prognosis from hospitals. We investigate relationship between the timing of mCPR setup and patients’ prognosis. Earlier mCPR setup is associated with better chance of ROSC among OHCA patient, especially those with initial shockable rhythm. For every one minute delay of completing mCPR setup, the odds of ROSC decreases by 10.8%. In addition, through different statistical and validation methods, we identify the proper mCPR setup timing cut point as 316 seconds to discriminate the prognosis of OHCA patients with mCPR application. Our findings provide paramedics with clear suggestions and training goals of mCPR setup time for OHCA patients with different initial rhythms. It also has the potential to develop into a guideline for the use of mCPR in the future.